Provider Demographics
NPI:1245370089
Name:HAMMER, JUDY LYNN (LMP LICENSED MASSAGE)
Entity type:Individual
Prefix:MS
First Name:JUDY
Middle Name:LYNN
Last Name:HAMMER
Suffix:
Gender:F
Credentials:LMP LICENSED MASSAGE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1478
Mailing Address - Street 2:
Mailing Address - City:ANACORTES
Mailing Address - State:WA
Mailing Address - Zip Code:98221-6478
Mailing Address - Country:US
Mailing Address - Phone:360-708-6535
Mailing Address - Fax:360-230-3070
Practice Address - Street 1:1004 M AVENUE
Practice Address - Street 2:SUITE 105
Practice Address - City:ANACORTES
Practice Address - State:WA
Practice Address - Zip Code:98221-4133
Practice Address - Country:US
Practice Address - Phone:360-708-6535
Practice Address - Fax:888-896-9894
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00013679225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0166112OtherWA DEPT LABOR AND INDUSTR
611739200OtherUS DEPT LABOR FECA NUMBER